On May 5, 2009, President Obama announced a six-year, $63 billion Global Health Initiative (GHI) which called for the U.S. to develop an integrated and comprehensive global health strategy that moves away from the fragmented and disease-specific approaches of the past. The GHI is meant to maintain the U.S.’s commitment to fighting HIV/AIDS and malaria, while scaling up programs in maternal and child health, family planning and neglected tropical diseases.

The announcement of the GHI came at a time when the debate over how to modernize and reform the U.S. approach to foreign assistance and global health and development had begun in full force. Global health is a critical piece of U.S. foreign assistance, and it is critical that the reforms that are hopefully on the horizon be developed hand-in-hand in a way that fits GHI seamlessly into the new foreign assistance framework, and that foreign assistance reform creates a favorable environment for the GHI to have the greatest possible impact on improving global health.

The GHI responds to the top priority of the Global Health Council and its members, as expressed in a letter (link downloads a PDF document) the Council sent to the Obama Transition Team in November 2008:

The Obama Administration should quickly advance a comprehensive, 5-year global health policy framework … The current U.S. approach to global health is a pastiche of programs and policies housed in various departments and agencies or presidential initiatives … Most of the affected populations need health services for multiple diseases and conditions, but U.S. programs are fragmented in design and delivery – so a poor person in Africa could receive U.S.-funded AIDS treatment drugs and not be tested for the TB infection that will compound his or her illness and may well prove fatal … The lack of an overarching global health policy framework with clear goals results in practices where progress in one area is often undermined by neglect in another and investments are not necessarily directed to the issues imposing the greatest health burdens or the populations in most need.

The GHI, as articulated by the Obama Administration, addresses many of these concerns. It also embodies basic objectives of foreign assistance reform efforts — increasing coordination among U.S. agencies, moving towards country-led/country-owned programs to build sustainability, better coordinating with other donors and improving results/metrics via improved monitoring and evaluation. The Global Health Council strongly supports the GHI and its potential to impact the larger U.S. foreign assistance reform effort positively. The principles of the GHI, as outlined in the government’s Global Health Initiative Consultation Document (link downloads a PDF document), respond to many of our concerns about the current system:

The right to the highest attainable standard of health, which includes the principles of non-discrimination and equality, participation and accountability, is universally recognized as fundamental to human dignity, freedom, and well-being. We believe that the Global Health Initiative aims to secure this right in the following critical areas:

First, it’s necessary to coordinate and leverage funding for health services. Individual countries are obliged to provide international development assistance and cooperation, and not interfere in the realization of the right to health in other countries. Secondly, it’s vital to meaningfully engage civil society and the private sector. Engaging civil society can create a political base for the most effective programming and implementation choices, and, on that basis, health outcomes. Civil society will also hold governments responsible and accountable for financial and political commitments made. Finally, it is necessary to maximize existing resources and build strong health systems that deliver integrated services for all, particularly poor women and children.

We are optimistic about the Global Health Initiative because we see, at its core, a commitment to these areas that we know are vital to a just and healthy life. In this series, launched here, we will explore how the Global Health Initiative might achieve great strides in these areas through its women-centered approach, its focus on country ownership and civil society engagement, its philosophy of integration and strengthening health systems and its investment in quality research, innovation and evaluation.

We hope you will join us for this series and contribute to the conversation. Feel free to start the discussion by posting your comment below.